Basic Information
| Provider Information | |||||||||
| NPI: | 1083733265 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KYLE | ||||||||
| FirstName: | TERESA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | RPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 577 LEE RD | ||||||||
| Address2: | |||||||||
| City: | HARTSELLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356406141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2567845760 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1792 AL HIGHWAY 157 | ||||||||
| Address2: | |||||||||
| City: | CULLMAN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 350583622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2567372831 | ||||||||
| FaxNumber: | 2567372829 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PTH1221 | AL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 51537375 | 01 | AL | BLUECROSSBLUESHIELD AL | OTHER |